States scramble to handle 'tsunami-like wave' of HIT demands

By Diana Manos
10:32 AM

With the health reform law expected to impact state Medicaid in 2014, a lot of states are scrambling to get their ducks in order to handle the onslaught of new beneficiaries and claims.

Will Saunders, group president of government healthcare solutions at Xerox says state healthcare workers are "the unsung heroes," since there are "incredible demands on them."

Despite the anticipated pressure, almost every state has hiring restrictions on state employees. Many of these employees have been working in Medicaid for decades and have seen "waves of mandates and waves of change." But, none of them have seen anything like "the tsunami-like wave" of change that will come in 2014 with the healthcare reform law, Saunders says.

 [See also: CMS certifies Massachusetts Medicaid System .]

Healthcare reform is expected to add 15 to 17 million people to the Medicaid program, requiring states to comply with "quite a few" new mandates by the fast-approaching date of Jan. 1, 2014, according to Saunders.

"Every state has an incredible desire to improve their systems and find true cost containment," Saunders says. "Medicaid covers the toughest, most chronically-ill people. Regardless of where healthcare reform goes, states are going to be challenged with the expense for being the safety net for those vulnerable citizens. Once you kind of meet and see the role that Medicaid plays, it’s remarkable."

Saunders knows first-hand the environment facing states and Medicaid. Xerox currently operates Medicaid systems for 12 states and the District of Columbia. The firm also works with 38 of 50 states, "one way or another," on their Medicaid programs, he says.

 [See also: Interoperability failure causes headaches for Maine Medicaid.]

This month, Xerox announced it is now managing the claims processing systems for California’s Medicaid program. This transfer of California’s Medicaid management information system (MMIS) to Xerox is a major milestone under the 10-year, $1.6 billion contract signed two years ago, Saunders says. Progress has been significant. Since assuming operational responsibility in October 2011, Xerox has processed more than 90 million claims totaling $7.5 billion.

Xerox’s take-over of the California MMIS last September "was a remarkable event," Saunders says. "The system hadn’t been in transition since 1988. The customer was rightfully diligent in making sure we were ready."

Xerox executed over 44,000 discreet tasks to make the transition, and they each had to be dovetailed in a 24-hour period with help of state leadership, according to Saunders. Success was due to the transparency Xerox and the state of California provided to providers and patients. "We didn’t get any complaints, things kept going without a hitch," he says.

 [See also: Florida awards $172M Medicaid contract to HP.]

Xerox has now hired more than 1,200 people in Sacramento, California, where the MMIS is based. Saunders says this is a tribute to healthcare reform creating jobs. Xerox is the largest employer in Sacramento.

"We have paid billions of claims, and millions in the first month," Saunders says. California is the largest Medicaid program in the country, with 8.5 million beneficiaries – 30 percent of the state – on Medicaid.

Follow Diana Manos on Twitter @DManos_IT_News.